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Individual

JASON M GROSDIDIER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
100 HIGHLINE DR, EAST WENATCHEE, WA 98802-5341
(509) 884-0614
Mailing address
820 N CHELAN AVE, WENATCHEE, WA 98801-2028

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00043600
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0184960
L&I
WA
05
1972534832
WA
01
P01290278
RR MEDICARE
WA
Enumeration date
07/06/2006
Last updated
06/21/2022
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